HHS-OIG study backs need for further Part D enforcement

by Ben Vernia | June 23rd, 2013

On June 20, the Office of Inspector General of the Department of Health and Human Services released a report concluding that 700 prescribers of drugs reimbursed by Medicare’s Part D program exhibited “questionable” prescribing patterns, including ordering extremely high numbers of prescriptions per beneficiary, having a very large number of pharmacies filling prescriptions, ordering large numbers of Schedules II and III drugs (which are prone to addiction and abuse), prescribing high rates of brand-name drugs, and having prescriptions filled by pharmacies with histories of questionable billing.

The OIG noted that this latest study was one of several related efforts, including studies that identified over 2600 retail pharmacies with suspicious billing practices, unreimburseable refilling of Schedule II drug prescriptions, the use of invalid prescriber identifiers, and weaknesses in the MEDIC Part D integrity contractor program.

The OIG also took note of a May 2013 ProPublica report which found lax oversight of prescribers in the Part D program.

To date, the Department of Justice is known to have intervened in just one whistleblower case raising allegations of fraud in Part D.

Disclosure: The Vernia Law Firm represents a whistleblower in a case alleging false claims submitted to Part D by Omnicare, a large long-term care facility pharmacy.

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